Management of fulminant myocarditis: a diagnosis in search of its etiology but with therapeutic options.
Management of fulminant myocarditis: a diagnosis in search of its etiology but with therapeutic options.
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DOI：
10.1007/s11897-014-0196-6
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发表时间：
2014-06-01
影响因子：
--
通讯作者：
Pankuweit, Sabine
中科院分区：
文献类型：
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作者：
Maisch, Bernhard;Ruppert, Volker;Pankuweit, Sabine
暴发性心肌炎是一种临床综合征，在疑似心肌炎的情况下，表现为急性心力衰竭、心源性休克或危及生命的节律紊乱。它不是一种病因学诊断，但可能有不同的潜在原因和发病过程-病毒，细菌，毒性和自身反应。急性期疾病实体的临床管理涉及重症监护室或类似环境中的血流动力学监测。快速常规检查是强制性的，包括连续心电图、超声心动图、心脏MRI、心脏导管插入术和肌内膜活检，用于组织学、免疫组织学和潜在感染和发病机制的分子分析。根据现行指南，所有病例均需进行心力衰竭治疗。对于暴发性自身反应性心肌炎，免疫抑制治疗是有益的;对于病毒性心肌炎，IVIg可以解决炎症，降低病毒载量，甚至根除微生物病原体。ECMO、IABP、心室辅助装置、LifeVest或ICD植入可以过渡到康复或心脏移植。
Fulminant myocarditis is a clinical syndrome with signs of acute heart failure, cardiogenic shock, or life-threating rhythm disturbances in the context of suspected myocarditis. It is not an etiological diagnosis, but may have different underlying causes and pathogenetic processes - viral, bacterial, toxic, and autoreactive. Clinical management of the disease entity at the acute stage involves hemodynamic monitoring in an intensive care unit or similar setting. Rapid routine work-up is mandatory with serial EKGs, echocardiography, cardiac MRI, heart catheterization with endomyocardial biopsy for histology, immunohistology, and molecular analysis for the underlying infection and pathogenesis. Heart failure therapy is warranted in all cases according to current guidelines. For fulminant autoreactive myocarditis, immunosuppressive treatment is beneficial; for viral myocarditis, IVIg can resolve the inflammation, reduce the viral load, and even eradicate the microbial agent. ECMO, IABP, ventricular assist devices, LifeVest, or ICD implantation can bridge to recovery or to heart transplantation.